The Benzathine Penicillin G (BPG) Reformulation Preferences Study - Tonga

Abstract

Acute Rheumatic Fever (ARF) is an autoimmune condition caused by untreated Group A Streptococcal (GAS) infection of the upper respiratory tract (and possibly skin). Multiple or severe attacks of ARF can cause cardiac damage, known as Rheumatic Heart Disease (RHD) which remains a significant cause of morbidity and mortality globally and is rare in developed countries. In Australia, New Zealand (NZ) and the Pacific Region, the disease burden of ARF and RHD amongst Indigenous and Pacific communities is one of the highest in the world, usually affecting children and young adults. A GAS vaccine remains years from being available and until then, the most effective recommended preventative measure for ARF requires painful monthly intramuscular injections of Benzathine Penicillin G (BPG) for 10 years or more, known as secondary prophylaxis (SP). Adherence to SP remains a challenge in many settings and improved understanding of barriers and novel approaches to BPG delivery are urgently needed. To create a reformulation of BPG that encourages SP adherence, insight is needed into the reformulation preferences of those with ARF/RHD. This work seeks to explore the experiences and investigate children/teen on SP, family, and healthcare professional and practitioner preferences for potential BPG reformulation characteristics in Tonga. Three software applications will be adapted from pre-developed applications already piloted and pretested, and optimized for use to ensure age, cultural appropriateness and efficient data collection. This is the first time software applications have been successfully developed and utilized to collect qualitative and quantitative data on individual preferences for BPG formulations and dosing regimens in Tonga.